You may be surprised to know that prior to 1987, premenstrual syndrome (PMS) was not in the textbooks or medical literature as a physiological condition. Rather, it was classified as psychogenic. In other words, it was “all in your head.” Clearly PMS has proven to be a condition beyond psychological imagination. In fact, millions of women suffer from PMS, with an estimate up to 75% of women at reproductive age.
What is PMS?
Premenstrual syndrome is defined as: A cyclical late luteal phase disorder of the menstrual cycle whereby the daily functioning of women is affected by emotional and physical symptoms substantially interfering with their quality of life (Hashim et al, 2016)
PMS encompasses a variety of symptoms including mood swings, irritability, depression, anxiety, breast tenderness, bloating, headaches, migraines, cravings, fluid retention and sleep disturbances. Generally, a cluster of consistent symptoms for 3 months of more are used to recognize PMS.
There are many proposed mechanisms for why PMS occurs: diet, nutritional deficiencies, stress, environmental toxins (i.e. chlorine and fluoride in water, estrogen disruptors in plastics, heavy metals, etc.), unresolved emotions, liver stagnation, and neurotransmitter deficiencies. It is likely several of these mechanisms work together to create unbalanced hormone fluctuations.
PMS occurs in the luteal phase (ovulation to menstruation) of a woman’s cycle, and typically symptoms arrive 5-7 days prior to menstruation. These symptoms are often resolved once menstruation begins.
Are women destined to have PMS? And what can diet do?
While PMS has become “normal”, it does not have to be. As mentioned, many factors contribute to the development and severity of PMS. Thus, modulating some of these factors can help alleviate or eliminate PMS. Let’s focus on diet.
Research and clinical evidence show that diets high in conventionally produced dairy, animal products, sugar, and refined carbohydrates worsen symptoms, while diets high in plants, fiber and Omega 3 fatty acids (fish, chia seeds, flax seeds) reduce symptoms. According to Dr. Mark Hyman, alcohol also contributes to problems because it damages the liver and prevents it from excreting excess estrogen. Excess estrogen is proposed to cause weight gain (especially around the hips), breast tenderness, and fluid retention or bloat in particular. Fiber helps reduce estrogen build up, so diets high in fiber help reduce symptoms. Both the Association of Reproductive Health Professionals and the American Congress of Gynecology and Obstetrics suggest that diets high in complex carbohydrates and low in sugar can improve symptom severity (Houghton et al 2018).
What about the gut? Doesn’t everything stem from the gut?
Our microbiome (or gut) plays a critical role in regulating, producing, absorbing, inhibiting and/or eliminating toxins, nutrients, pathogens, neurotransmitters, and hormones to name a few. Since PMS is connected to all the above, it is safe to say the health of your gut plays a big role. For instance, if you are constipated, you cannot eliminate toxins or excess estrogen. If you have chronic diarrhea, your electrolytes and nutrients will likely be deficient. Some nutrients like magnesium, calcium and vitamin B6 play a crucial role in the menstrual cycle and hormonal balance.
Another way the gut influences PMS symptoms is by producing enzymes that help break down the estrogen into its inactive form. Gut bacteria also produce neurotransmitters like serotonin. Alterations in the availability of serotonin is a possible cause of PMS (Brown, 2016). So again, diet plays an important role – feeding the “good” bacteria that help absorb and assimilate certain nutrients, and produce the enzymes, hormones, and neurotransmitters required for hormonal balance.
What about alternative therapies?
Eighty percent of women suffering from PMS seek complementary and alternative therapies (Abdi, Ozgoli & Rahnemaie, 2019) including acupressure, acupuncture, massage, and cognitive behavioral therapy. These therapies help modulate symptoms, reduce stress, and balance biochemistry. Light therapy and/or exposure to natural light also helps because light increases serotonin production. Interestingly, PMS is correlated with seasonal affective disorder (in winter) and lower Vitamin D levels.
Herbs can also help regulate the stress response, increase focus, and improve energy flow. Some common herbs used for PMS include lemon balm, lemon verbena, dandelion and lavender. I’ve seen particular success with raspberry leaf. If you are on medication, please always check with your doctor or nutritionist before using herbal therapies.
What’s the take away?
PMS is not a normal way of life, nor should it take away a woman’s right to happiness and emotional stability. Reducing PMS requires a multi-factorial and holistic approach focusing on nutrition, exercise, lifestyle, stress reduction, and avoidance of environmental toxins to the best of one’s ability. Improving gut health through proper dietary intake, fulfilling nutritional needs, and supporting the liver to enable elimination of estrogen and toxins can enable the body to achieve hormonal balance.